Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: A cost-effectiveness analysis

• Published in: American journal of infection control Vol. 42; no. 4; pp. 412 - 416
• Main Authors: Wong, Carlos, Luk, In-wa, Ip, Margaret, You, Joyce H.S.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2014; Elsevier; Mosby-Year Book, Inc
• Subjects: Abdomen; Administration, Topical; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - economics; Bacteria; Biological and medical sciences; Cost-Benefit Analysis; Dialysis; Direct medical costs; Disease prevention; Emergency and intensive care: renal failure. Dialysis management; Epidemiology. Vaccinations; Exit site infection; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Gram-positive bacteria; Gram-Positive Bacterial Infections - economics; Gram-Positive Bacterial Infections - prevention & control; Health Care Costs; Health risks; Hong Kong; Humans; Infection Control; Infection Control - economics; Infection Control - methods; Infectious Disease; Infectious diseases; Intensive care medicine; Medical personnel; Medical sciences; Monte Carlo simulation; Mortality; Mupirocin; Mupirocin - administration & dosage; Mupirocin - economics; Nosocomial infections; Other diseases. Semiology; Pathogens; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritonitis; Peritonitis - economics; Peritonitis - prevention & control; Quality of Life; Quality-adjusted life-years; Sensitivity analysis; Survival Analysis; Hong Kong; Asia; China; Hong Kong China; Mupirocin; Direct medical costs; Quality-adjusted life-years; Exit site infection; Peritonitis; Human; Costs; Check; Peritoneal dialysis; Infection; Prevention; Extrarenal dialysis; Antibiotic; Gram positive bacteria; Health economy; Abdominal disease; Quality; Cost analysis; Antibacterial agent; Public health; Cost efficiency analysis
• ISSN: 0196-6553; 1527-3296; 1527-3296
• DOI: 10.1016/j.ajic.2013.12.008

Gram-positive bacteria are the major causative pathogens of peritonitis and exit site infection in patients undergoing peritoneal dialysis (PD). We investigated the cost-effectiveness of regular application of mupirocin at the exit site in PD recipients from the perspective of health care providers in Hong Kong. A decision tree was designed to simulate outcomes of incident PD patients with and without regular application of mupirocin over a 1-year period. Outcome measures included total direct medical costs, quality-adjusted life-years (QALYs) gained, and gram-positive infection–related mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables. In a base case analysis, the mupirocin group had a higher expected QALY value (0.6496 vs 0.6456), a lower infection-related mortality rate (0.18% vs 1.64%), and a lower total cost per patient (US $258 vs $1661) compared with the control group. The rate of gram-positive peritonitis without mupirocin and the risk of gram-positive peritonitis with mupirocin were influential factors. In 10,000 Monte Carlo simulations, the mupirocin group had significantly lower associated costs, higher QALYs, and a lower mortality rate 99.9% of the time. Topical mupirocin appears to be a cost-effective preventive measure against gram-positive infection in incident patients undergoing PD. The cost-effectiveness of mupirocin is affected by the level of infection risk reduction and subject to resistance against mupirocin.